With the knowledge that international comparisons of care provide valuable opportunities for participating countries to identify areas of improvement in their own patient care, a report published May 9 in the International Journal of Cardiology examined patterns of in-hospital treatment and use of interventional diagnostic and therapeutic procedures among patients admitted with non ST-segment elevation myocardial infarction (NSTEMI) in the UK, Sweden and the U.S., and found that the care for these patients “differed substantially among the three countries.”

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Led by Robert McNamara, MD, MHS, FACC, Yale University School of Medicine, the investigation utilized data spanning from 2007 to 2010 from the MINAP/NICOR (n = 137,009), the SWEDEHEART/RIKS-HIA (n = 45,069), and the ACTION Registry-GWTG (n = 147,438).

The results of the investigation showed that despite having the youngest population, the U.S. had higher rates of smoking, diabetes, hypertensions, prior heart failure, and prior myocardial infarction than in Sweden or the UK. The data also showed that angiography and percutaneous coronary intervention (PCI) were performed more often in U.S. (76 percent and 44 percent) and Sweden (65 percent and 42 percent) than the UK (32 percent and 22 percent), and that discharge beta blockers were prescribed more often in the U.S. (89 percent) and Sweden (89 percent) than in the UK (76 percent). However, discharge statins, angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB), and dual antiplatelet agents (among those not receiving PCI) were shown to be higher in the UK (92 percent, 79 percent, and 71 percent) than in the U.S. (85 percent, 65 percent, 41 percent) and Sweden (81 percent, 69 percent, and 49 percent).

While the study found that in-hospital management in terms of interventional procedures for NSTEMI patients was more aggressive in the U.S. and Sweden than the UK, the McNamara and his co-authors noted that this gap appears to be narrowing over time. Ultimately McNamara et al. conclude that understanding differences in patient characteristics and hospital management are critical preludes to comparing outcomes and identifying areas for improvement in each country.

Keywords: Angiotensin Receptor Antagonists, Registries, Myocardial Infarction, Platelet Aggregation Inhibitors, Patient Discharge, Hypertension, Diabetes Mellitus, Smoking, Percutaneous Coronary Intervention, National Cardiovascular Data Registries, ACTION Registry

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